Enhanced Analgesic And Optimizations Of General Anesthesia In Elderly Patients

Objective: Contrast the optimization results of general anesthesia with different dosesof fentanyl in elderly patients with laparoscopic cholecystectomy, discussion optimizesecurity, controllability and comfortreasonable by strengthening analgesic anesthesia inelderly patients.Methods: Sixty ASA I or II patients aged65～82y undergoing elective laparoscopiccholecystectomy were randomly divided into three groups: according to different inductiondoses of fentanyl: fentanyl4μg/kg group (group A, n=20), fentanyl6μg/kg group (groupB, n=20), fentanyl8μg/kg group (group C, n=20). In every group anesthesia wasmaintained with propofol given by TCI, setting the plasma concentration2.5μg/ml, and atthe same time of the inducing of propofol, the fentanyl was bolused as the doses of settingwithin2minutes:4μg/kg in group A,6μg/kg in group B, and8μg/kg in group C. After thedisappearance of consciousness, inject vecuronium0.1mg/kg. While3minutes later,implement the intubation. After the intubation, reduce the plasma concentration to2.0μg/ml and maintaining. Before the start of surgery, fentanyl4μg/kg were added in eachgroup. While according the surgery, if MAP>120%baseline values or BIS>60, addfentanyl1μg/kg; if MAP <80%, give Alaminl0.2mg; While if HR <45/min, giveatropine0.5mg. Every30minutes give vecuronium0.05mg/kg. Record blood pressure,heart rate and BIS values in case of different stimuli, and record the cycle stability andquality as well as wake of side reactions in three groups.Results: Three groups have no significant differences between the basic information(age, sex, BMI, surgery and anesthesia times, complicating diseases, etc.)(P>0.05). Afterinduction of anesthesia (T1), in group C, mean arterial pressure and BIS values decreased significantly higher than in group A (P <0.05); After intubation (T2) the mean arterialpressure in group A rise higher than T0, and BIS values of group A increased significantlygreater than group B and group C (P <0.05); Due to lack of analgesia, the additional offentanyl was significantly greater in group A than group B and C (P <0.05); Comparedwith group A and B, group C needs more Alamin because of the severe circulatorydepression (P <0.05); The amount of propofol, recovery time, extubation time andanalgesic score has no difference in three groups (P>0.05); The respiratory rate in groupC was lower than group A and group B (P <0.05); Sedation score and Analgesic score ingroup B and C were better than group A (P <0.05); Antagonist of naloxone and thenumber of cases of adverse reactions has no difference in three groups (P>0.05).Conclusions: In the present study we designed for elderly patients using propofolinduction TCI2.5μg/ml and different doses of fentanyl, before the start of surgery appendfentanyl4μg/kg, and maintained with propofol TCI2.0μg/ml. Fentanyl4μg/kg inductionand intubation, the patient must appear stress response and higher BIS values, among thesurgery, the number of fentanyl additional must significantly increased and postoperativerecovery slightly lower quality; while fentanyl increased to8μg/kg may be more effectivein inhibiting the stress response intubation and surgical stimulation, but the number ofAlamin used during anesthesia significantly increased; while to6μg/kg fentanyl induction,induction and maintenance of anesthesia can be more better in controling the stressresponse in patients with less intraoperative use of vasoactive drugs, and with a highquality of surgery awake, fewer adverse reactions.